What Does a Psychiatrist Do Besides Prescribe Medication?
Written by the Prescribed Wellness Psychiatry team · Medically reviewed by Veronica Sanchez, MD · Updated October 2026
A psychiatrist's main job is medical judgment, and the prescription is only one tool in it. In a psychiatry visit, the doctor takes a full history, examines you, looks for medical causes of your symptoms, measures whether treatment is working, adjusts or stops medication, recommends treatments that are not medication, and talks to the other people caring for you.
People often picture psychiatry as a short visit that ends in a prescription pad. The visit is short, and a prescription is often part of it. But the thinking that leads up to the prescription, and the follow-up that comes after it, is most of the work. Here is what that actually involves.
Key takeaways✓ A psychiatrist is a medical doctor, so the first job is diagnosis: sorting out what is happening and whether something physical is contributing. ✓ Measuring progress with a questionnaire or scale, rather than relying on memory, is part of good psychiatric care and is recommended in national treatment guidelines. ✓ Psychiatrists are trained in psychotherapy, and are also trained to recommend treatments that are not medication at all, including cognitive behavioral therapy for insomnia. ✓ Deciding when and how to stop a medication is as much a part of the job as deciding when to start one. ✓ If you want the short version of who handles what, we wrote a separate piece on what a psychiatrist, therapist and primary care doctor each do. |
What happens in a psychiatric visit before anything is prescribed?
A long conversation happens first. The American Psychiatric Association practice guidelines for the psychiatric evaluation of adults (third edition, 2015) describe what an initial evaluation should cover: your current symptoms, your psychiatric history and what you have already tried, trauma, substance use including alcohol and prescription misuse, suicide risk, your cultural and social situation, and your general medical health.
The guidelines also ask the psychiatrist to explain the differential diagnosis to you. A differential diagnosis is the short list of conditions that could explain your symptoms, and why one fits better than the others. Then the plan is made with you, based in part on what you want. That conversation is the reason a first appointment takes about an hour rather than fifteen minutes. We go through it step by step in our post on what to expect at a first psychiatric evaluation.
Why does a psychiatrist ask about your body and your other medications?
Because some physical conditions look like psychiatric ones, and some medications cause psychiatric symptoms. The American Psychiatric Association practice guidelines for the psychiatric evaluation of adults specifically direct the psychiatrist to review your medical conditions, your neurological and sensory health, your sleep, and every medication and supplement you take, along with their side effects.
There is no blood test for depression or anxiety. Lab work in psychiatry is not used to make the diagnosis. It is used to rule other things in or out, and to keep certain medications safe over time. Thyroid problems, anemia, sleep apnea and a long list of medicines can all produce low mood, poor concentration or panic. Finding one of those changes the plan completely.
This is also why your psychiatrist wants to know about supplements. Several interact with psychiatric medications, and patients reasonably do not think of them as drugs.
How does a psychiatrist tell whether treatment is working?
By measuring, not by guessing. The VA/DoD clinical practice guideline for major depressive disorder (version 4.0, February 2022) suggests using a quantitative measure of depression severity in initial treatment planning, and monitoring progress at regular intervals to guide decisions together with the patient. In practice that means a brief questionnaire, such as the nine-item depression scale many clinics use, scored at visits so there is a number to compare.
This matters more than it sounds. Memory for mood is unreliable, in both directions. A person who has improved substantially often reports feeling "the same", because the comparison point has moved. A score from eight weeks ago settles the question. The same guideline notes that no particular monitoring schedule has been shown to beat another, so the interval is a judgment call rather than a rule.
Measurement also protects you from staying on something that is not helping. If you want the detail on how long to give a medication before judging it, we published a week-by-week timeline for antidepressants.
Are psychiatrists trained to do therapy?
Yes, all of them. Under the ACGME requirements for psychiatry training, residents must demonstrate competence in "brief and long-term supportive, psychodynamic, and cognitive-behavioral psychotherapies", and in treating patients "using pharmacological regimens, including concurrent use of medications and psychotherapy". The same requirements cover coordinating care for patients who are seeing a non-medical therapist.
What varies is how a given psychiatrist uses that training. Some provide formal therapy themselves. Some focus on diagnosis and medication and work closely with a therapist, which is the more common arrangement in outpatient practice. Either way, the therapeutic part of a medication visit is real: explaining the illness, addressing the fear that comes with a diagnosis, and helping someone decide what they want is not filler around the prescription.
When does a psychiatrist recommend something other than medication?
Often, and the guidelines expect it. For major depression, the VA/DoD clinical practice guideline for major depressive disorder recommends treatment with either psychotherapy or medication on its own, chosen with the patient's preference in mind. Neither is positioned as the automatic first move.
Insomnia is the clearest example. The American Academy of Sleep Medicine guideline on behavioral treatments for chronic insomnia (Edinger and colleagues, 2021) gives its single strong recommendation to multicomponent cognitive behavioral therapy for insomnia, usually shortened to CBT-I, and suggests clinicians not use sleep hygiene advice as a treatment on its own. So a patient who comes in asking for a sleeping pill may leave with a referral for CBT-I instead, or alongside.
Exercise comes up the same way, with honest limits on what the evidence can promise. We went through what the exercise research actually shows in a separate post, including where the research is weaker than the headlines suggest.
Saying "this does not need a medication" is a clinical judgment, and it is one of the more useful things a psychiatrist can tell you.
Who else does a psychiatrist talk to?
With your permission, the people already involved in your care. Consultation is a formal part of psychiatric training: the ACGME requirements for psychiatry training require competence in "providing psychiatric consultation in a variety of medical and surgical settings" and in "acting in a consultative role to other physicians and health professionals".
There is evidence this changes outcomes. In a trial of 1,801 adults aged 60 and over published in JAMA in 2002, depression care organized around a care manager who was supervised by a psychiatrist and worked with the patient's primary care doctor produced a 50% or greater drop in depressive symptoms for 45% of patients at twelve months, compared with 19% of those getting usual care. That is one trial, in older adults, in primary care settings, so it does not describe every situation. But it points at something real: coordinated care works better than care delivered in separate boxes.
In ordinary practice this looks like a note to your therapist so you are not explaining yourself twice, a call to your primary care doctor about a medication interaction, or a letter for a specialist. None of it happens without your written consent.
Does a psychiatrist help you stop a medication, too?
Yes, and that is part of the same job. The National Institute of Mental Health advises that people should not stop a prescribed medication on their own, even when they feel better, and notes that stopping too soon can cause unpleasant or harmful effects.
There is also a question of timing. For someone whose depression has gone into remission on an antidepressant, the VA/DoD clinical practice guideline for major depressive disorder recommends continuing the medication at the same dose for at least six months to lower the chance of relapse. Beyond that, how long to stay on treatment depends on how many episodes you have had and how severe they were, and it is a decision to make with your prescriber rather than from an article.
When stopping is the right move, the work is in the plan: the pace of the reduction, what to watch for, what to do if symptoms come back, and when to check in. Nobody should have to do that alone or by trial and error.
What does this look like at Prescribed Wellness Psychiatry?
Dr. Veronica Sanchez is a board-certified psychiatrist and sees adults at 3800 Barham Blvd, Suite 416, in the Cahuenga Pass, next door to the Warner Bros. lot and about a minute from Burbank, with parking in the building. Universal City, Studio City and Toluca Lake are all a short drive away.
A first evaluation is scheduled for 50 minutes, and follow-up visits are 25 minutes. Visits are available in person or by secure video anywhere in California, in English or in Spanish. Many patients alternate between the two, and most come into the office in person about once a year.
What a follow-up actually covers: how you have been since the last visit, side effects, sleep, any new medications from another doctor, and whether the current plan is still the right one. If something outside psychiatry needs attention, we say so and help you get to the right person.
The practice is enrolled with Medicare in California, so Medicare patients can be seen in person in Los Angeles and by secure video anywhere in the state, including Bakersfield and San Diego. Here is what Medicare covers for psychiatry and what you can expect to pay. For plans we are not contracted with, we provide a superbill you can submit yourself, and self-pay patients get a Good Faith Estimate before the first visit. Coverage and costs vary by plan, so please verify your own benefits.
How do I book an appointment?
Call or text (626) 681-3729, or request an appointment online. Intake forms are sent to you before the first visit, and the current patients page has the details on forms, refills and messaging.
If you are not sure whether you need a psychiatrist, a therapist or your primary care doctor, that is a reasonable thing to be unsure about, and it is a fine question to bring to a first appointment.
Frequently asked questions
Is medication management just refilling a prescription?
No. A medication management visit is a short medical appointment. Your psychiatrist checks whether symptoms are improving, asks about side effects, reviews sleep, appetite, energy and other medicines, and decides whether to keep, change, add or stop something. A refill is the paperwork at the end, not the visit.
Do psychiatrists do therapy?
Many do, and all are trained in it. Psychiatry residents must show competence in supportive, psychodynamic and cognitive-behavioral psychotherapy, per the ACGME training requirements. In practice, some psychiatrists provide therapy themselves, and some focus on diagnosis and medication while working alongside a therapist.
Does a psychiatrist order blood tests?
Sometimes. There is no blood test for depression or anxiety. Lab work is used to look for medical conditions that can imitate or worsen psychiatric symptoms, such as thyroid problems or low iron, and to monitor certain medications safely. Whether you need any depends on your history and your other care.
Can a psychiatrist help me come off a medication?
Yes, and stopping well is part of the job. The National Institute of Mental Health advises not stopping a prescribed medication on your own, because stopping too soon can cause unpleasant or harmful effects. A psychiatrist can plan the timing, reduce the dose gradually, and watch for symptoms returning.
Do I still need a therapist if I see a psychiatrist?
Often, yes, and the two work well together. The National Institute of Mental Health notes psychiatric medications are frequently used along with psychotherapy. Which combination fits you depends on your diagnosis, how severe things are, and what you want. For the guidelines on major depression, either one alone is a reasonable start.
Can a psychiatrist work with my primary care doctor?
Yes. Consulting with other physicians is a formal part of psychiatric training, and it matters when medicines or medical conditions interact. With your written permission, Dr. Sanchez can share a plan with your primary care doctor, your therapist, or another specialist, so everyone is working from the same information.
Sources
American Psychiatric Association. Practice Guidelines for the Psychiatric Evaluation of Adults, third edition, 2015. psychiatryonline.org
Accreditation Council for Graduate Medical Education. Program Requirements for Graduate Medical Education in Psychiatry, effective September 3, 2025. acgme.org
U.S. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder, version 4.0, February 2022 (Recommendations 2, 6 and 21). healthquality.va.gov
Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262. doi:10.5664/jcsm.8986
Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836-2845. doi:10.1001/jama.288.22.2836
National Institute of Mental Health. Mental Health Medications. nimh.nih.gov
Medical disclaimer: This article is for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor a guarantee of insurance coverage. Coverage rules and costs change and vary by plan; always verify your benefits. If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
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